Quality prescribing for Benzodiazepines and z-drugs: guide for improvement 2024 to 2027

Appendix 6: A practice policy example

Anxiolytic & Hypnotic Prescribing Practice Policy

Starting individuals on benzodiazepine or z-drug (B-Z-drugs)

• Restrict B-Z-drugs use: to individuals in whom alternative options have been tried and failed or considered inappropriate.
• Acute prescription only. For symptomatic use on an as needed basis. Not regular basis.
• For a maximum of seven days and advise the individual that it cannot be repeated within four weeks from the date of issue.
• Do not add B-Z-drugs to the repeat prescription list.
• Do not prescribe 5mg or 10mg strength of diazepam tablets due to their black-market value. Only use diazepam 2mg tablets.
• If B-Z-drugs are to be initiated, then include a caution message on the label: “Warning this drug may cause dependence on long-term use”
• Display a poster to inform individuals of the practice policy in the waiting area (Appendix 3)
• Encourage practice staff to make individuals aware of the new policy when requests are made for B-Z-drugs

Existing practice individuals that are currently prescribed a B-Z-drug

• Should be informed of policy as outlined above.
• Remove B-Z from repeat prescription list. Send a letter to the individual informing them that their B-Z will now need to be ordered as an acute prescription. Invite individual for review (Appendix 4).
• Individuals will be reviewed by one of the GPs (and/or general practice clinical pharmacist)* to discuss implementing a plan to reduce and stop the drug(s) in a structured and supported manner, if safe and appropriate to do so. NB Remember to refer to exclusion list.
• Arrange and agree follow up at a time that is suitable to the individual, e.g. phone review during the individual’s working day may help individuals engage with supported review and reduction.
• Continued issuing of prescriptions should be informed by the individual’s progress
• Poor individual engagement with practice policy (without good reason). Arrange regular contact with the individual to reinforce the message at every opportunity.
• Over ordering. Restrict quantities. Consider weekly dispense.

Newly registered individuals already taking B-Z drug

• Should be informed of policy as outlined above.
• Individuals will be reviewed by one of the GPs (and/or general practice clinical pharmacist) to discuss implementing a reduce and discontinue drug(s) in a structured and supported manner if safe and appropriate to do so. NB Remember to refer to exclusion list.

* The majority of individuals should be reviewed by their own GP. Where individuals have had their B-Z reviewed, reduced and discontinued by their GP they are more likely to stay off B-Z medication. Proactively reviewing and reducing B-Z creates an opportunity to reflect on prescribing practice, change behaviours and improve sustainability. Where it is appropriate for pharmacists to review individuals, the reviews should be split: 80% GP and 20% pharmacist.